WHY PARENTS SHOULD SAY 'YES' TO IMMUNIZATIONS FOR THEIR CHILDREN

If you choose not to vaccinate your child, you are putting more than just him at risk. Drs. Elaine Barfield and Eunice Rhee make the case for getting your child the proper vaccines before it's too late.

The media was recently bustling with the withdrawal in February of a controversial article published in The Lancet in 1998 that ignited a decade-long scare of the MMR vaccine as a possible cause of autism. The paper was published in the U.K. by Andrew Wakefield, M.D., suggesting that the MMR vaccine caused a series of events including intestinal inflammation, entrance of harmful proteins into the bloodstream which were harmful to the brain, and consequent development of autism. In support of his hypothesis, Dr. Wakefield described twelve children with developmental delay, eight of whom had autism. After more than a decade since publication, the paper was withdrawn by The Lancet, stating that "it has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation."

The truth is that each year, scores of children still die of vaccine preventable illnesses. During the last year alone, the world has experienced multiple outbreaks of diseases, most of which would have been preventable with careful vaccine administration. On the one hand, it is true that vaccination programs have led to the decline of many vaccine-preventable diseases, so that whooping cough, measles, and polio have been eradicated or are at very low levels in the United States. However, some of these diseases are still quite prevalent in other parts of the world, and people traveling here from other countries can unknowingly bring these diseases into the United States.

One example of this is the measles outbreak that occurred during the 2010 Olympics in Vancouver. Despite the fact that measles is very rare in Vancouver (due to high vaccination rates), two separate strains of the measles found their way to the city toward the end of the Olympic Games, likely from visitors from India and the western Pacific. During the outbreak, over 16 individuals had confirmed cases, eight of those occurring in a single household that regularly and intentionally refuses vaccines.

Additionally, a recent article in Pediatrics highlights the story of a seven-year-old, intentionally unimmunized boy who brought measles into the United States after returning from Switzerland in 2008. This resulted in the exposure of 839 people near San Diego to the disease. These are frightening statistics.

Dispelling the Myths

As young pediatricians, we often find ourselves frustrated as we attempt, often unsuccessfully, to dispel myths and inaccuracies that are portrayed constantly by celebrities and the media about the so-called dangers of vaccines. Many of our parents are too young to recall the terrible courses of the measles, varicella, and mumps, to name a few, that afflicted thousands of children decades ago. Before the measles vaccine's development in 1963, the disease took more than 500 lives each year. Parental refusal of vaccines for their children rose from 22 percent in 2003 to 39 percent in 2008, according to the study conducted by the CDC's National Immunization Survey. Dr. Paul Offit, chief of the division of infectious diseases and the director of the Vaccine Education Center at the Children's Hospital of Philadelphia, said in a recent interview, "I think the retraction [of Wakefield's article suggesting that the MMR vaccine causes autism] is far too little far too late. The Lancet published a hypothesis that was unsupported and has since been disproven by careful scientific study. But there is no undoing the harm of that original paper. Many parents abandoned the MMR vaccine. As a consequence, hundreds of children were hospitalized and four were killed by measles. This retraction will do nothing to change that."

As Dr. Offit points out, the retraction of this controversial paper certainly does not change the past decade of fear, distrust, and misinformation surrounding vaccine safety. However, we as pediatricians hope that this news will hopefully lead to more open and informed conversations between parents and pediatricians regarding vaccines. It is in the hopes of encouraging such conversations between the readers of this magazine and their pediatricians that we write this article.

Another common fear by many parents is that vaccinating their children will cause their children to actually contract the diseases contained in the vaccines. With the exception of a few, most vaccines are comprised of killed or extremely weak versions of the disease the vaccine is aiming to protect your child against. When vaccines are injected into fatty tissue or muscle, the vaccine's components are not strong enough to cause symptoms and signs of the disease, but are just strong enough to trigger the immune system to produce antibodies against them. The memory cells that remain in the body after the vaccine is given help to prevent re-infection if and when the child encounters that disease in the future. By having the vaccine, the child develops immunity without suffering from the actual disease.

There are a few "live" vaccines, meaning that a portion of the vaccine is comprised of a live version of that particular virus. One example is varicella. These vaccines, according to the Center for Disease Control, are still safe for most children and teenagers unless they are immunocompromised or pregnant. In a sense, the vaccine tricks the body into thinking it is under attack by the virus, and the immune system is triggered to provide a defense against the disease when a real infection becomes a threat.

Infancy: A Critical Time

Another major concern voiced by many of the parents we encounter in clinic is the sheer number of vaccines being administered to their children at once. Children are exposed to numerous antigens (foreign substances that stimulate the production of immunity within the body) every day from the moment they are born. The food we feed our infants introduces new bacteria into the body, and many normal bacteria actually reside in the mouth, nose, and intestines, exposing the immune system to multiple antigens at the same time. A virus/cold can expose a child to four to 10 antigens, and a case of "strep throat," to 25 to 50. Babies are capable of responding to these germs because they have the ability to make antibodies. Given the plethora of antigens your child is exposed to daily from birth (from the household environment, siblings, babysitters, and daycare), the administration of three to four vaccines in one office visit is well under the number of antigens they will likely encounter in a single day.

Immunizing children as early as possible against several of the vaccine-preventable diseases (such as measles, pertussis, and tetanus) gives them protection during the vulnerable infancy period. For example, pertussis affects roughly 8,000 children a year in the U.S., and results in five to 10 deaths each year. Almost all of the cases are in children less than one year of age. Children under two years are 500 times more likely to become ill with H. influenza B (Hib) meningitis if someone with a Hib infection is living in the home. Additionally, giving several vaccinations at the same time will mean fewer office visits for vaccinations, which saves parents both time and money and may ultimately be less traumatic for the child.

New Developments

Recently there have been many exciting developments with regard to vaccines. Currently, females age nine and older are advised to have the Gardasil vaccine series to prevent the spread of HPV, the virus that causes cervical, anal, and penile cancer. A new HPV vaccine has recently been approved for males, which means that pediatricians will be able to protect all children from several forms of cancer caused by this virus. In addition, a new pneumococcal (pneumonia) vaccine was recently developed that includes six additional strains than the previous vaccine, again providing increased protection against many of the more resistant strains of pneumococcus.

Finally, after experiencing a frightening epidemic of H1N1 (a type of influenza A) in 2009, the H1N1 vaccine was developed to provide immunity against this re-emerging virus. Despite the fact that the H1N1 vaccine was manufactured in the exact same way as the seasonal influenza vaccine, many parents in our clinics refused to allow their children to have this vaccine during the 2009-2010 winter season because it was "new." As clinicians, we found this frustrating because what parents did not realize was that the seasonal influenza vaccine that they did allow their children to have was manufactured anew this season, as well - as it is every season.

It is critical to remember that refusing vaccines for one's child not only puts that particular child at risk, but also puts multiple other children at risk. Children at an even greater risk include infants under two months, children with HIV or other immunodeficiencies, and children on chemotherapy or with bone marrow transplants.

Given these facts, we hope this article will at the very least encourage a more open dialogue among parents and pediatricians about how to best protect their children.

The authors are both third-year residents in pediatrics at NY Presbyterian Hospital-Weill Cornell Medical Center. Elaine Barfield attended Princeton University and NYU School of Medicine. Eunice Rhee studied Brain and Cognitive Sciences at MIT and attended UMDNJ - Robert Wood Johnson Medical School. This article was written as part of their advocacy and community pediatrics rotation at New York Hospital Queens.